| NPI | 1831892173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO TL.0009629) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0009629) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2024-10-13 |